Pharmacological treatment of major depressive disorder in adolescents

Major depressive disorder (MDD) affects a significant number of adolescents today. Its consequences (including social isolation, failure to achieve crucial developmental milestones, and suicide) mandate close attention in clinical practice. While tricyclics and monoamine oxidase inhibitors (MAOIs) have been used infrequently and with questionable efficacy, selective serotonin reuptake inhibitors (SSRIs), particularly fluoxetine, consistently have been shown to be of benefit in treating outpatient adolescents with MDD. Despite some success with other drugs in its class, fluoxetine remains the only SSRI that is FDA approved for treatment of children and adolescents with depression. A review of recent studies is presented, including the controversy regarding the relationship of antidepressants and suicidal behavior in this patient population.